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Publication Assessment of the Impact of Schizophrenia on Healthcare Resource Use Among Patients with Cardiometabolic Conditions in England: Insights from Big Data Analysis(Pharman Ltd, 2019-07) Rabe, Adrian Paul J.; Hassan, Yasir; Tait, David J.; Health iQ, London; Coventry and Warwickshire Partnership NHS Trust; Medicines Management; Additional Professional Scientific and Technical Field; Tait, DavidObjectives Having schizophrenia increases the risk of developing cardiometabolic conditions, increasing costs and complicating management. This retrospective cohort study among patients with cardiometabolic conditions in England aimed to determine the impact of comorbid schizophrenia on primary and secondary healthcare use, and on the costs of nonelective inpatient admissions, as well as whether this burden is influenced by the number of a patient’s cardiometabolic conditions. Methods Primary and secondary healthcare use data were collected from the Clinical Practice Research Datalink and Hospital Episode Statistics databases, respectively. Adults with ≥1 cardiometabolic condition(s) were grouped according to the conditions, and whether they had schizophrenia. Healthcare resource use, and costs of nonelective admissions were calculated for patient with/without schizophrenia and any, 1, 2, 3, or 4 cardiometabolic condition(s). Results were adjusted for age and sex. Abstract Results Patients with comorbid schizophrenia had 68% more GP appointments (18.09 versus 11.07 appointments/patient/ year), 19% more prescriptions (4.20 versus 5.06 prescriptions/ patient/year), 21% more outpatient appointments (7.94 versus 6.60 appointments/patient/year), 189% more A&E attendances (2.31 versus 0.80 attendances/patient/year), and 127% more nonelective inpatient admissions (1.69 versus 0.77 admissions/patient/year) than those without. The higher number of nonelective admissions represented £1,420.36 increased spending/patient/year, translating into a potential spend of more than £31M annually. Schizophrenia was associated with higher secondary care resource use after adjusting for the number of cardiometabolic conditions. Conclusions Among patients with cardiometabolic conditions, comorbid schizophrenia is associated with higher primary and secondary healthcare resource use and cost, even after adjusting for the number of cardiometabolic conditions.Publication Distinct alterations in probabilistic reversal learning across at-risk mental state, first episode psychosis and persistent schizophrenia(Nature Research, 2024-07) Griffin, J. D.; Diederen, K. M. J.; Haarsma, J.; Jarratt Barnham, I. C.; Cook, B. R. H.; Fernandez-Egea, E.; Williamson, S.; van Sprang, E. D.; Gaillard, R.; Vinckier, F.; Goodyer, I. M.; NSPN Consortium; Murray, G. K.; Fletcher, P. C.; University of Cambridge; Institute of Psychiatry, London; Wellcome Centre for Human Neuroimaging, Queen Square, UCL, London; Cambridgeshire and Peterborough NHS Trust; Coventry and Warwickshire NHS Partnership Trust; University Medical Centres (UMC), Amsterdam; Paris Descartes University; Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences; Institut du Cerveau et de la Moelle épinière (ICM);; Psychiatry; Medical and Dental; Williamson, SWe used a probabilistic reversal learning task to examine prediction error-driven belief updating in three clinical groups with psychosis or psychosis-like symptoms. Study 1 compared people with at-risk mental state and first episode psychosis (FEP) to matched controls. Study 2 compared people diagnosed with treatment-resistant schizophrenia (TRS) to matched controls. The design replicated our previous work showing ketamine-related perturbations in how meta-level confidence maintained behavioural policy. We applied the same computational modelling analysis here, in order to compare the pharmacological model to three groups at different stages of psychosis. Accuracy was reduced in FEP, reflecting increased tendencies to shift strategy following probabilistic errors. The TRS group also showed a greater tendency to shift choice strategies though accuracy levels were not significantly reduced. Applying the previously-used computational modelling approach, we observed that only the TRS group showed altered confidence-based modulation of responding, previously observed under ketamine administration. Overall, our behavioural findings demonstrated resemblance between clinical groups (FEP and TRS) and ketamine in terms of a reduction in stabilisation of responding in a noisy environment. The computational analysis suggested that TRS, but not FEP, replicates ketamine effects but we consider the computational findings preliminary given limitations in performance of the model.Publication The Association Between Trajectories of Self-reported Psychotic Experiences and Continuity of Mental Health Care in a Longitudinal Cohort of Adolescents and Young Adults(Oxford University Press, 2024-08) Gerritsen, Suzanne E; Bolhuis, Koen; van Bodegom, Larissa S; Maras, Athanasios; Overbeek, Mathilde M; van Amelsvoort, Therese Amj; Wolke, Dieter; de Girolamo, Giovanni; Franić, Tomislav; Madan, Jason; McNicholas, Fiona; Paul, Moli; Purper-Ouakil, Diane; Santosh, Paramala; Schulze, Ulrike M E; Singh, Swaran P; Street, Cathy; Tremmery, Sabine; Tuomainen, Helena; Dieleman, Gwen C; Mesman, Esther; Erasmus Medical Center; Yulius Mental Health Organization, Dordrecht; ARQ National Psychotrauma Centre, Diemen; Vrije Universiteit Amsterdam; University of Maastricht; Mondriaan Mental Health Care, Heerlen; University of Warwick; IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia; University Hospital Split; University of Split; University College Dublin; Lucena CAMHS, SJOG, Dublin; Coventry and Warwickshire Partnership NHS Trust; Saint Eloi Hospital, Montpellier; University Paris Saclay; Kings College London; South London and Maudsley NHS Foundation Trust; HealthTracker Ltd, Kent; University of Ulm; Department of Neurosciences, KU Leuven; Psychiatry; Medical and Dental; Paul, MoliBackground and hypothesis: Young people (YP) with psychotic experiences (PE) have an increased risk of developing a psychiatric disorder. Therefore, knowledge on continuity of care from child and adolescent (CAMHS) to adult mental health services (AMHS) in relation to PE is important. Here, we investigated whether the self-reported trajectories of persistent PE were associated with likelihood of transition to AMHS and mental health outcomes. Study design: In this prospective cohort study, interviews and questionnaires were used to assess PE, mental health, and service use in 763 child and adolescent mental health service users reaching their service's upper age limit in 8 European countries. Trajectories of self-reported PE (3 items) from baseline to 24-month follow-up were determined using growth mixture modeling (GMM). Associations were assessed with auxiliary variables and using mixed models. Study results. At baseline, 56.7% of YP reported PE. GMM identified 5 trajectories over 24 months: medium increasing (5.2%), medium stable (11.7%), medium decreasing (6.5%), high decreasing (4.2%), and low stable (72.4%). PE trajectories were not associated with continuity of specialist care or transition to AMHS. Overall, YP with PE reported more mental health problems at baseline. Persistence of PE or an increase was associated with poorer outcomes at follow-up. Conclusions: PE are common among CAMHS users when reaching the upper age limit of CAMHS. Persistence or an increase of PE was associated with poorer mental health outcomes, poorer prognosis, and impaired functioning, but were less discriminative for continuity of care.Publication Designing and implementing a physical exercise intervention for people with first episode psychosis using experience-based co-design: A pilot study from Chennai, India(Elsevier, 2024-07) Vijayalakshmi, U; Padmavati, R; Raghavan, Vijaya; Chandrasekaran, Sangeetha; Mohan, Greeshma; Durairaj, Jothilakshmi; Currie, Graeme; Lilford, Richard; Furtado, Vivek; Madan, Jason; Birchwood, Maximilian; Meyer, Caroline; Sood, Mamta; Chadda, Rakesh K; Mohan, Mohapradeep; Shah, Jai; John, Sujit; Iyer, Srividya N; Thara, R; Singh, Swaran; Schizophrenia Research Foundation, Chennai, India; All India Institute of Medical Sciences, New Delhi; Douglas Mental Health University Institute; Montreal; McGill University; University of Warwick; University of Birmingham; Coventry and Warwickshire Partnership Trust; Psychiatry; Medical and Dental; Singh, SwaranBackground: Physical exercise can improve outcomes for people with first-episode psychosis (FEP). Co-designing physical exercise interventions with end users has the potential to enhance their acceptability, feasibility, and long-term viability. This study's objective was to use experience-based co-design (EBCD) methodology to develop a physical exercise intervention for FEP, and pilot test it. Methods: The study was conducted at the Schizophrenia Research Foundation's FEP program in Chennai, India. Participants(N=36) were individuals with FEP and their caregivers, mental health professionals (MHPs, and physical training experts. EBCD methodology included one-to-one interviews, focus group discussions, joint conferences, and co-design workshops. Two instructional videos were developed. Twelve FEP patients engaged in physical exercise with help of the videos over three months. They were followed up through weekly phone calls and in-person interviews to capture data on regularity, frequency, location of exercise, and comfort levels. Results: Several touch points emerged from the interviews, focus groups, and joint meetings including lack of motivation, knowledge about physical exercise; differing perspectives about physical exercise; limited resource, and time constraints. Two instructional videos demonstrating activities for participants incorporated strategies that addressed these touch points. Pilot data indicated that participants engaged with the physical exercise intervention over 3 months. Conclusion: This was the first study to use co-design methodology to design a physical exercise intervention for first-episode psychosis. The intervention may have therefore been responsive to stakeholder needs and preferences. Results of this study highlight the potential of co-design in designing and adapting interventions. There is need for rigorous testing with larger samples.Publication The psychosis risk timeline: can we improve our preventive strategies? Part 3: primary common pathways and preventive strategies(Cambridge University Press, 2019-06-21) Romain, Karen; Eriksson, Alexandra; Onyon, Richard; Kumar, Manoj; Coventry and Warwickshire Partnership NHS Trust; Midlands Partnership Foundation Trust; University of Keele; Psychiatry; Medical and Dental; Romain, Karen; Eriksson, Alexandra; Onyon, RichardPsychosis is a recognised feature of several psychiatric disorders and it causes patients significant distress and morbidity. It is therefore important to keep knowledge of possible risk factors for psychosis up to date and to have an overview model on which further learning can be structured. This article concludes a three-part series. It gives a review of evidence regarding common pathways by which many risk factors come together to influence the development of psychosis and finalises our suggested overview model, a psychosis risk timeline. The three primary pathways considered are based on the major themes identified in this narrative review of recent literature and they focus on neurological, neurochemical and inflammatory changes. We link each back to the factors discussed in the first and second parts of this series that alter psychosis risk through different mechanisms and at different stages throughout life. We then consider and summarise key aspects of this complex topic with the aim of providing current and future clinicians with a model on which to build their knowledge and begin to access and understand current psychosis research and implications for future preventive work.Publication The psychosis risk timeline: can we improve our preventive strategies? Part 2: adolescence and adulthood(Cambridge University Press, 2019-06-24) Romain, Karen; Eriksson, Alexandra; Onyon, Richard; Kumar, Manoj; Coventry and Warwickshire Partnership NHS Trust; Midlands Partnership Foundation Trust; University of Keele; Psychiatry; Medical and Dental; Romain, Karen; Eriksson, Alexandra; Onyon, RichardCurrent understanding of psychosis development is relevant to patients' clinical outcomes in mental health services as a whole, given that psychotic symptoms can be a feature of many different diagnoses at different stages of life. Understanding the risk factors helps clinicians to contemplate primary, secondary and tertiary preventive strategies that it may be possible to implement. In this second article of a three-part series, the psychosis risk timeline is again considered, here focusing on risk factors more likely to be encountered during later childhood, adolescence and adulthood. These include environmental factors, substance misuse, and social and psychopathological aspects.Publication Effectiveness of online social networking interventions on social isolation and quality of life of people with psychosis: A systematic review(Elsevier, 2024-09) Thelwell, Emily L R; Dunkerley, Laura; Goodwin, Robin; Giacco, Domenico; University of Warwick; Coventry and Warwickshire Partnership NHS Trust; Psychiatry; Medical and Dental; Dunkerley, Laura; Giacco, DomenicoBackground: Social isolation is frequent in people with psychosis, contributing to negative health outcomes. Interventions including online social networking (OSN) may overcome some psychosis-related barriers and facilitate social interactions. However, evidence is currently sparse and needs to be collated in a systematic review to better understand effectiveness. Method: Following PRISMA guidelines, this review yielded 9835 results. Eleven publications, reporting data from five RCTs and six non-controlled studies, met the inclusion criteria. Two independent reviewers undertook data extraction and quality assessment, with results narratively synthesised. Results: This review looked broadly at interventions including either purpose-build platforms for peer-to-peer interactions or existing OSN tools. Yet, we only identified interventions utilising purpose-designed platforms. Early small-scale studies suggested OSN interventions reduced social isolation, but larger effectiveness studies did not confirm these effects. No improvements in quality-of-life outcomes were identified. Conclusion: Higher quality and longer-term studies did not support effectiveness of current OSN interventions in reducing social isolation or improving quality of life of people with psychosis. These interventions used purpose-built platforms and encouraged OSN between selected individuals, which may explain these outcomes. Future research may explore promoting safe use of mainstream OSN platforms to expand the social networks of individuals with psychosis.Publication The Importance of Social Cognition in Improving Functional Outcomes in Schizophrenia(Frontiers, 2018-04-24) Javed, Afzal; Charles, Asha; Coventry and Warwickshire Partnership NHS Trust; Psychiatry; Medical and Dental; Javed, Afzal; Charles, AshaSocial cognition has become recognized as an important driver of functional outcomes and overall recovery in patients with schizophrenia, mediating the relationship between neurocognition and social functioning. Since antipsychotic therapy targeting remission of clinical symptoms has been shown to have a limited impact on social cognition, there has been an increasing drive to develop therapeutic strategies to specifically improve social cognition in schizophrenia. We sought to review current evidence relating to social cognition in schizophrenia and its clinical implications, including interventions designed to target the core domains of social cognition (emotion processing, theory of mind, attributional bias, and social perception) as a means of improving functional outcomes and thereby increasing the likelihood of recovery. Relevant articles were identified by conducting a literature search in PubMed using the search terms "schizophrenia" AND "cognition" AND "social functioning," limited to Title/Abstract, over a time period of the past 10 years. Current evidence demonstrates that schizophrenia is associated with impairments in all four core domains of social cognition, during the pre-first-episode, first-episode, early, and chronic phases of the disease, and that such impairments are important determinants of functional outcome. Interventions targeting the four core domains of social cognition comprise psychosocial approaches (social cognition training programs) and pharmacological therapies. Social cognition training programs targeting multiple and specific core domains of social cognition have shown promise in improving social cognition skills, which, in some cases, has translated into improvements in functional outcomes. Use of some psychosocial interventions has additionally resulted in improvements in clinical symptoms and/or quality of life. Pharmacological therapies, including oxytocin and certain antipsychotics, have yielded more mixed results, due in part to the confounding impact of factors including variation in receptor genetics, bioavailability, pharmacokinetics, and drug-drug interactions, and inconsistencies between study designs and medication dosages. Additional research is required to advance our understanding of the role of social cognition in schizophrenia, and to further establish the utility of targeted interventions in this setting.Publication The association between treatment beliefs and engagement in care in first episode psychosis(Elsevier, 2018-08-09) Perry, Benjamin Ian; Kular, Ariana; Brown, L; Gajwani, Ruchika; Jasani, Rubina; Islam, Zoebia; Birchwood, Max; Singh, Swaran P; University of Warwick; Coventry and Warwickshire Partnership NHS Trust; Birmingham Women's and Children's NHS Foundation Trust; University of Glasgow; University of Manchester; LOROS Hospice, United Kingdom; Psychiatry; Medical and Dental; Perry, Benjamin Ian; Singh, Swaran P.Disengagement from mental health services poses an important problem for people with psychosis. Lack of treatment adherence is associated with poorer physical health, reduced social functioning, an increased rate of relapse and an increased likelihood of being legally detained (O'Brien et al., 2009). Previous research has uncovered differences in treatment beliefs based upon either differences in causal attributions (McCabe and Priebe, 2004) and ethnic/racial group (Jimenez et al., 2012), however the impact of differing treatment beliefs on engagement in care has not been examined. This is an important extension since if it can be evidenced that differing treatment beliefs are associated with variation in engagement, services may seek to realign to account for these differences. We aimed to complete a secondary analysis of a pre-existing cohort to examine; 1) whether different treatment beliefs were associated with engagement in care; and 2) the influence of sociodemographic differences on treatment beliefs and whether these differences extended to engagement in care.Publication QI 1189 Delivering Family Intervention (FI) Across Early Intervention in Psychosis Service(Coventry and Warwickshire Partnership NHS Trust, 2024) Warr, Louise; Supported by the Quality Improvement Team, Coventry and Warwickshire Partnership Trust; Coventry and Warwickshire Partnership NHS Trust; Early Intervention in Psychosis Service; Additional Professional Scientific and Technical Field; Warr, LouiseAim: To increase the number of families being offered family intervention (FI) by 30% and to increase the number of families receiving FI by 30% across the Early Intervention Service. Family Intervention (FI) is an intervention that NICE state should be offered to all families on the Early Intervention (EI) caseload. CWPT’s offer of FI is BFT. The National Clinical Audit of Psychosis (NCAP) measures how well each service delivers this, historically we have scored poorly in comparison to other Trusts. We have previously trained staff in BFT, expected them to deliver this as part of their role, offered ad hoc supervision, put BFT leads into teams, and told staff they needed to provide BFT. These approaches did not improve our score. Using the learning from the North Warwickshire QI project which improved the uptake of BFT, a different approach has been tried. There is now a dedicated FI team and Clinical Lead. They have used QI methodology to understand where the barriers are for delivering BFT, used this information to create different approaches to deliver, worked with staff to challenge professional bias and change to the culture around FI and carers support. Numbers of families being offered BFT has increased across all the service but the number of families receiving BFT has not significantly increased. When it is being declined it is the families making an informed choice rather than staff making the decision on their behalf. The feedback is that BFT is being offered too early (within 12 weeks) therefore this is now being offered again later.Publication QI 110 To Improve Access for Families to Family Intervention in the North Warwickshire Early Intervention Team (EIT)(Coventry and Warwickshire Partnership NHS Trust, 2024) Warr, Louise; Supported by the Quality Improvement Team, Coventry and Warwickshire Partnership Trust; Coventry and Warwickshire Partnership NHS Trust; Early Intervention Team; Additional Professional Scientific and Technical Field; Warr, LouiseAim: To increase the number of families offered family interventions (FI) in North Warwickshire EIT by 10% by September 2022. FI should be offered to all families who receive an EIT service. Data from the 2020/21 National Clinical Audit of Psychosis (NCAP) showed we were underperforming (14%) and were identified as an outlier for this audit standard. Quality improvement methodology was used to scope the available data to understand the current process by mapping referrals and the last 10 patients. A driver diagram was developed to identify change ideas which could be implemented within the North Warwickshire EIT service. Using Plan, Do, Study, Act (PDSA) cycles we were able to see whether the change had been effective. The statistical process control (SPC) chart (left) illustrates the number of people being offered FI and whether the change has been sustainable. Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; SPC Charts - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf. Project Impact: The project aim has been exceeded-Number of families being offered FI has increased by a mean of 262% . Other identified benefits: •Clearer pathways in place for clinicians to identify families. •Stepped care approach embedded into EIT practice. •Robust supervision in place. •New Family Intervention Team being appointed.Publication QI 117 Improving Physical Health Care Provided by Coventry 11-17 (Psychosis Pathway) Team(Coventry and Warwickshire Partnership NHS Trust, 2024) Hassan, Shahnaz; Supported by the Quality Improvement Team, Coventry and Warwickshire Partnership Trust; Coventry and Warwickshire Partnership NHS Trust; Psychiatry; Medical and Dental; Hassan, ShahnazAim: By 9 July 2022 for patients open to medical staff only in the Coventry Recovery Team (N=96): 1. 30% will have been offered an appointment to complete the lifestyle screening tool. 2. 20% will have had a physical health and lifestyle screening tool completed. The trust requires that all patients open to the service with psychotic disorders have an annual physical health screening assessment. Prior to this project there was a nurse and health care led process in place which was unable to meet these requirements. Baseline data showed that of those patients only open to the medical team 13.5% had been offered a physical health screen and only 12.5% had a completed assessment over the past 3 years. Tools Used: PDSA - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; SPC - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-process.pdf; Project Impact: Completed physical health assessments increased from baseline by 20% up to 32.5% at week 16. Cycle 2: aimed at non-attendance. Providing generic information improved this by 3.6% but a personalised letter to non-attenders at a 1st appointment (n=3) resulted in them all attending a 2nd appointment.Publication Opening the Black Box of Cognitive-Behavioural Case Management in Clients with Ultra-High Risk for Psychosis(Karger, 2017-09-14) Hartmann, Jessica A; McGorry, Patrick D; Schmidt, Stefanie J; Amminger, G Paul; Yuen, Hok Pan; Markulev, Connie; Berger, Gregor E; Chen, Eric Y H; de Haan, Lieuwe; Hickie, Ian B; Lavoie, Suzie; McHugh, Meredith J; Mossaheb, Nilufar; Nieman, Dorien H; Nordentoft, Merete; Riecher-Rössler, Anita; Schäfer, Miriam R; Schlögelhofer, Monika; Smesny, Stefan; Thompson, Andrew; Verma, Swapna Kamal; Yung, Alison R; Nelson, Barnaby; University of Melbourne; University of Bern; University of Cologne; Child and Adolescent Psychiatric Service of the Canton of Zurich; University of Hong Kong; University of Sydney; Medical University of Vienna; University of Amsterdam; Copenhagen University Hospital; University of Basel Psychiatric Hospital; Jena University Hospital; University of Warwick; Coventry and Warwickshire Partnership NHS Trust; Institute of Mental Health, Singapore; University of Manchester;; Psychiatry; Medical and Dental; Thompson, AndrewBackground Cognitive Behavioural Therapy (CBT) is the first-choice treatment in the ultra-high risk (UHR) for psychosis group. However, CBT is an umbrella term for a plethora of different strategies, and little is known about the association between intensity and content of CBT and severity of symptomatic outcome. Methods A sample of 268 UHR participants received six months of cognitive behavioural therapy with case management (CBCM) in the context of the multi-centre Neurapro trial with monthly assessments of attenuated psychotic symptoms (APS). Using multilevel regressions and controlling for initial severity of APS, the association between (1) number of CBCM sessions received and severity of APS, and (2) specific CBCM components and severity of APS, were investigated. Results In Month 1, a higher number of sessions and more assessment of symptoms predicted an increase of APS, while in Month 3, a higher number of sessions and more monitoring predicted a decrease in level of APS. More therapeutic focus on APS predicted an increase of APS overall. Conclusions Our findings indicate that the association between intensity/content of CBCM and severity of APS in a sample of UHR participants depends on time in treatment. CBCM may positively impact severity of APS later in the course of treatment. Therefore, it would seem important to keep UHR young people engaged in treatment beyond this initial period. Regarding the specific content of CBCM, a therapeutic focus on APS may not necessarily be beneficial in reducing the severity of APS, a possibility in need of further investigation.Publication Associated illness severity in schizophrenia and diabetes mellitus : a systematic review(Elsevier, 2017-06-13) Perry, Benjamin Ian; Salimkumar, Dhanya; Green, Daniel; Meakin, Anne; Gibson, Andrew; Mahajan, Deepali; Tahir, Tayyeb; Singh, Swaran; University of Warwick; Coventry and Warwickshire Partnership NHS Trust; Cardiff and Vale NHS Trust; Psychiatry; Medical and Dental; Perry, Benjamin Ian; Gibson, Andrew; Singh, SwaranObjective We aimed to elucidate whether schizophrenia and type II diabetes mellitus may present with associated illness severity, in light of accumulating evidence to suggest both conditions have important shared inflammatory components with many shared inflammatory genetic factors. Methods We conducted a systematic review employing PRISMA criteria, searching EMBASE, Ovid MEDLINE, PsychInfo, Web of Science and Google Scholar to February 1st, 2017, for clinical studies assessing schizophrenia severity alongside dysglycaemia. A narrative synthesis was employed to discuss and compare findings between studies. Results Eleven observational studies were included in the analysis. Ten presented evidence in support of an association between schizophrenia severity and dysglycaemia. This association appeared particularly strong regarding negative symptomatology and impaired cognitive function, between which there may be some overlap. Studies examining positive symptomatology returned mixed results. Conclusion Whilst study design varied amongst the included studies, the results suggest that further work examining the effect of hyperglycaemia on schizophrenia severity may be relevant, particularly longitudinal studies assessing negative symptomatology and cognitive function. To the authors’ knowledge, this is the first systematic review conducted to address this question.Publication Sleep and postpartum psychosis : a narrative review of the existing literature(MDPI, 2023-12-07) Carr, Camilla; Borges, Daniela; Lewis, Katie; Heron, Jessica; Wilson, Sally; Broome, Matthew R; Jones, Ian; Di Florio, Arianna; Morales-Muñoz, Isabel; University of Birmingham; Coventry and Warwickshire Partnership NHS Trust; Cardiff University; Action on Postpartum Psychosis, Swansea SA3 9BT, UK; Birmingham Women's and Children's NHS Foundation Trust; Psychiatry; Medical and Dental; Borges, DanielaSleep problems are extremely common during the postpartum period. The role of sleep in the development of postpartum psychosis (PP) is, however, still under-researched. This narrative review aims to (1) provide a summary of the existing evidence for the associations between sleep problems and PP, (2) discuss the relevant risk factors associated with sleep problems and PP, and (3) suggest future lines of research in this area. Some of the existing literature suggests an association between sleep problems, specifically insomnia, sleep loss and sleep disruption during pregnancy and postpartum, and PP, with the most relevant risk factors including history of bipolar disorder and time of delivery. However, it is still unclear whether the previously mentioned sleep problems are a symptom of, or a trigger for PP. Thus, further research is needed to identify the specific role of sleep problems in PP, using longitudinal designs and more objective measures of sleep. This will allow appropriate detection, intervention and support for women experiencing and/or at risk for PP.Publication Predicting treatment resistance in positive and negative symptom domains from first episode psychosis : development of a clinical prediction model(Elsevier, 2024-09-10) Lee, Rebecca; Griffiths, Sian Lowri; Gkoutos, Georgios V; Wood, Stephen J; Bravo-Merodio, Laura; Lalousis, Paris A; Everard, Linda; Jones, Peter B; Fowler, David; Hodegkins, Joanne; Amos, Tim; Freemantle, Nick; Singh, Swaran P; Birchwood, Max; Upthegrove, RachelBackground: Treatment resistance (TR) in schizophrenia may be defined by the persistence of positive and/or negative symptoms despite adequate treatment. Whilst previous investigations have focused on positive symptoms, negative symptoms are highly prevalent, impactful, and difficult to treat. In the current study we aimed to develop easily employable prediction models to predict TR in positive and negative symptom domains from first episode psychosis (FEP). Methods: Longitudinal cohort data from 1027 individuals with FEP was utilised. Using a robust definition of TR, n = 51 (4.97 %) participants were treatment resistant in the positive domain and n = 56 (5.46 %) treatment resistant in the negative domain 12 months after first presentation. 20 predictor variables, selected by existing evidence and availability in clinical practice, were entered into two LASSO regression models. We estimated the models using repeated nested cross-validation (NCV) and assessed performance using discrimination and calibration measures. Results: The prediction model for TR in the positive domain showed good discrimination (AUC = 0.72). Twelve predictor variables (male gender, cannabis use, age, positive symptom severity, depression and academic and social functioning) were retained by each outer fold of the NCV procedure, indicating importance in prediction of the outcome. However, our negative domain model failed to discriminate those with and without TR, with results only just over chance (AUC = 0.56). Conclusions: Treatment resistance of positive symptoms can be accurately predicted from FEP using routinely collected baseline data, however prediction of negative domain-TR remains a challenge. Detailed negative symptom domains, clinical data, and biomarkers should be considered in future longitudinal studies.Publication Collaborative care intervention for individuals with severe mental illness: the PARTNERS2 programme including complex intervention development and cluster RCT(NIHR Journals Library [Governmental Publisher], 2024-07) Plappert, Humera; Byng, Richard; Reilly, Siobhan Theresa; Hobson-Merrett, Charley; Allard, Jon; Baker, Elina; Britten, Nicky; Calvert, Melanie; Clark, Michael; Creanor, Siobhan; Davies, Linda; Denyer, Rebecca; Frost, Julia; Gask, Linda; Gibbons, Bliss; Gibson, John; Gill, Laura; Gwernan-Jones, Ruth; Hosking, Joanne; Huxley, Peter; Jeffery, Alison; Jones, Benjamin; Keeley, Tom; Laugharne, Richard; Marwaha, Steven; Planner, Claire; Rawcliffe, Tim; Retzer, Ameeta; Richards, Debra; Sayers, Ruth; Williams, Lynsey; Pinfold, Vanessa; Birchwood, Max; University of Birmingham; University of Plymouth; University of Bradford; Cornwall Partnership NHS Foundation Trust; Livewell Southwest, Plymouth, UK; University of Exeter; The London School of Economics and Political Science; University of Manchester; Coventry and Warwickshire Partnership NHS Trust; The McPin Foundation, London; University of Bangor; GlaxoSmithKline, Brentford, UK; Birmingham and Solihull Mental Health Trust; Lancashire Care NHS Trust; University of Warwick; Mental Health; Additional Professional Scientific and Technical Field; Gibbons, BlissExcerpt Background and aims: Individuals living with severe mental illness such as schizophrenia and bipolar can have significant emotional, cognitive, physical and social challenges. Most people with severe mental illness in the United Kingdom do not receive specialist mental health care. Collaborative care is a system of support that combines clinical and organisational components to provide integrated and person-centred care. It has not been tested for severe mental illness in the United Kingdom. We aimed to develop and evaluate a primary care-based collaborative care model (PARTNERS) designed to improve quality of life for people with diagnoses of schizophrenia, bipolar or other psychoses when compared with usual care. Methods: Phase 1 included studies to (1) understand context: an observational retrospective study of primary and secondary care medical records and an update of the Cochrane review ‘Collaborative care approaches for people with severe mental illness’; (2) develop and formatively evaluate the PARTNERS intervention: a review of literature on collaborative care and recovery, interviews with key leaders in collaborative care and recovery, focus groups with service users and a formative evaluation of a prototype intervention model; and (3) develop trial science work in this area: a core outcome set for bipolar and recruitment methods. In phase 2 we conducted a cluster randomised controlled trial measuring quality of life using the Manchester Short Assessment of Quality of Life and secondary outcomes including time use, recovery and mental well-being; a cost-effectiveness study; and a mixed-methods process evaluation. Public involvement underpinned all of the workstream activity through the study Lived Experience Advisory Panel and the employment of service user researchers in the project team. Results phase 1: The study of records showed that care for individuals under secondary care is variable and substantial and that people are seen every 2 weeks on average. The updated Cochrane review showed that collaborative care interventions were highly variable, and no reliable conclusions can be drawn about effectiveness. The PARTNERS model incorporated change at organisational, practitioner and individual levels. Coaching was selected as the main form of support for individuals’ personal goals. In the formative evaluation, we showed that more intensive supervision and ‘top-up’ training were needed to achieve the desired shifts in practice. A core outcome set was developed for bipolar, and measures were selected for the trial. We developed a stepped approach to recruitment including initial approach and appointment. Results phase 2: The trial was conducted in four areas. In total, 198 participants were recruited from 39 practices randomised. Participants received either the PARTNERS intervention or usual care. The follow-up rate was 86% at 9–12 months. The mean change in overall Manchester Short Assessment Quality of Life score did not differ between the groups [0.25 (standard deviation 0.73) for intervention vs. 0.21 (standard deviation 0.86) for control]. We also found no difference for any secondary measures. Safety outcomes (e.g. crises) did not differ between those receiving and those not receiving the intervention. Although the costs of intervention and usual care were similar, there is insufficient evidence to draw conclusions about the overall cost-effectiveness of PARTNERS. The mixed-methods process evaluation demonstrated that a significant proportion of individuals did not receive the full intervention. This was partly due to care partner absence and participant choice. The in-depth realist informed case studies showed that participants generally appreciated the support, with some describing having a ‘professional friend’ as very important. For some people there was evidence that delivery of the intervention had led to specific personal changes. Strengths and limitations: The phase 1 records study provided insights into usual care that had not been previously documented. The realist informed complex intervention development was both theoretical and pragmatic. The trial continued through the COVID-19 pandemic with high levels of follow-up. The process evaluation had the depth to explore individual changes in participants’ response to the intervention. Weaknesses in the trial methodology included suboptimal implementation, outcome measures that may not have been sensitive to changes patients most appreciated and difficulties collecting some outcomes. Conclusions: While PARTNERS was not shown to be superior to usual care, the change to PARTNERS care was not shown to be unsafe. Full intervention implementation was challenging, but this is to be expected in studies of care that include those with psychosis. Some individuals responded well to the intervention when psychological support in the form of individualised goal setting was flexibly deployed, with evidence that having access to a ‘professional friend’ was experienced as particularly helpful for some individuals. Future work: Key components of the PARTNERS model could be developed further and tested, along with improved supervision in the context of ongoing community mental health care change. Trial registration: This trial is registered as ISRCTN95702682. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: NIHR200625) and is published in full in Programme Grants for Applied Research; Vol. 12, No. 6. See the NIHR Funding and Awards website for further award information.Publication How "global" is research in early intervention for psychosis? A bibliometric analysis(Elsevier, 2024-06) Valle, Ruben; Singh, Swaran P; Loch, Alexandre Andrade; Iyer, Srividya N; McGill University, Montreal; University of Warwick; Coventry and Warwickshire Partnership Trust; Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil; Douglas Mental Health University Institute, Montreal; Acute Psychological Services; Additional Professional Scientific and Technical Field; Singh, Swaran PIntroduction: Unlike high-income countries (HICs), there are few early intervention services for psychosis in low-and middle-income countries (LAMICs). In HICs, research spurred the growth of such services. Little is known about the state of EIP research in LAMICs, which we address by examining their research output and collaborations vis-à-vis that of HICs. Methods: We conducted a search in Scopus database for early psychosis publications in scientific journals since 1980. Data from each record, including title, author affiliation, and date, were downloaded. For HIC-LAMIC collaborations, data on first, corresponding and last authors' affiliations, and funding were manually extracted. Descriptive statistics and social network analysis were conducted. Results: Globally, early psychosis publications increased from 24 in 1980 to 1297 in 2022. Of 16,942 included publications, 16.1 % had LAMIC authors. 71.3 % involved authors from a single country (regardless of income level). 21.9 % were collaborations between HICs, 6.6 % between HICs and LAMICs, and 0.2 % among LAMICs. For research conducted in LAMICs and involving HIC-LAMIC collaborations, the first, last, and corresponding authors were LAMIC-based in 71.8 %, 60.7 %, and 63.0 %, respectively. These positions were dominated (80 %) by authors from four LAMICs. 29.4 % of the HIC-LAMIC subset was funded solely by LAMIC funders, predominantly two LAMICs. Conclusions: LAMICs are starkly underrepresented in the otherwise flourishing body of early psychosis research. They have far fewer collaborations and less funding than HICs. Closing these gaps in LAMICs where most of the world's youth live is imperative to generate the local knowledge needed to strengthen early psychosis services that are known to improve outcomes.Publication Finding order within the disorder: A case study exploring the meaningfulness of delusions(Royal College of Psychiatrists, 2022-04) Ritunnano, Rosa; Humpston, Clara; Broome, Matthew; Institute for Mental Health, University of Birmingham; Coventry and Warwickshire NHS Partnership Trust; Birmingham Women’s and Children’s NHS Foundation Trust; Psychiatry; Medical and Dental; Ritunnano, RosaCan delusions, in the context of psychosis, enhance a person’s sense of meaningfulness? The case described here suggests that, in some circumstances, they can. This prompts further questions into the complexities of delusion as a lived phenomenon, with important implications for the clinical encounter. While assumptions of meaninglessness are often associated with concepts of ‘disorder’, ‘harm’ and ‘dysfunction’, we suggest that meaning can nonetheless be found within what is commonly taken to be incomprehensible or even meaningless. A phenomenological and value-based approach appears indispensable for clinicians facing the seemingly paradoxical coexistence of harmfulness and meaningfulness. (PsycInfo Database Record (c) 2022 APA, all rights reserved)Publication Improved social functioning following social recovery therapy in first episode psychosis: Do social cognition and neurocognition change following therapy, and do they predict treatment response?(Elsevier, 2021-02) Lowri Griffiths, Siân; Wood, Stephen J.; Fowler, David; Freemantle, Nick; Hodgekins, Joanne; Jones, Peter B.; Singh, Swaran P; Sharma, Vimal; Birchwood, Max; University of Birmingham; Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne; University of Melbourne; University of Sussex; University College London; University of East Anglia; University of Cambridge; University of Warwick; University of Chester; Cheshire and Wirral Partnership NHS Foundation Trust; Acute Psychological Services; Medical and Dental; Singh, SwaranThere is a need to develop and refine psychosocial interventions to improve functioning in First Episode Psychosis (FEP). Social cognition and neurocognition are closely linked to functioning in psychosis; examinations of cognition pre- and post- psychosocial intervention may provide insights into the mechanisms of these interventions, and identify which individuals are most likely to benefit. Method Cognition was assessed within a multi-site trial of Social Recovery Therapy (SRT) for individuals with FEP experiencing poor functioning (<30 h weekly structured activity). Fifty-nine participants were randomly allocated to the therapy group (SRT + Early intervention), and 64 were allocated to treatment as usual group (TAU - early intervention care). Social cognition and neurocognition were assessed at baseline and 9 months; assessors were blind to group allocation. It was hypothesized that social cognition would improve following therapy, and those with better social cognition prior to therapy would benefit the most from SRT. Results There was no significant impact of SRT on individual neurocognitive or social cognitive variables, however, joint models addressing patterns of missingness demonstrate improvement across a number of cognitive outcomes following SRT. Further, regression analyses showed those who had better social cognition at baseline were most likely to benefit from the therapy (ß = 0.350; 95% CI = 0.830 to 8.891; p = .019). Conclusion It is not clear if SRT impacts on social cognitive or neurocognitive function, however, SRT may be beneficial in those with better social cognition at baseline.